scholarly journals Cystic Dilation of Extrahepatic Bile Ducts in Adulthood: Diagnosis, Surgical Treatment and Long. Term Results

HPB Surgery ◽  
1998 ◽  
Vol 10 (6) ◽  
pp. 379-385 ◽  
Author(s):  
G. Belli ◽  
G. Rotondano ◽  
A. D'Agostino ◽  
A. Iannelli ◽  
I. Marano ◽  
...  
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Operative Mortality ◽  
Anastomotic Stricture ◽  
Long Term Results ◽  
Type I ◽  
Hida Scan ◽  
Extrahepatic Bile Ducts ◽  
Results Of Surgery

To evaluate the long-term results of surgery for choledohal cyst in adulthood, a series of 13 patients over the age of 16 operated on for choledochal cyst during a period of six years and followed-up for a minimum of 3 years was analyzed. Patients with type I and IVa cysts underwent extrahepatic cyst resection and Roux-en-Y hepatico-jejunostomy. Choledochoceles (type III) were managed endoscopically. No operative mortality or morbidity occurred. Type I and III cysts showed almost ideal follow-up with no sign of stricture on HIDA scan. One type IVa cyst patients developed recurrent cholangitis due to anastomotic stricture, managed percutaneously. Whenever possible, complete cyst resection and Roux-en-Y reconstruction is the treatment of choice for all extrahepatic biliary cysts. Intra- and extrahepatic dilatations are adequately treated by extrahepatic resection and careful endoscopic or radiologic surveillance. Small choledochoceles can be safely managed by endoscopic sphincterotomy.

Anterior Palatoplasty for the Treatment of OSA

2009 ◽  
Vol 141 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Kenny P. Pang ◽  
Raymond Tan ◽  
Puravi Puraviappan ◽  
David J. Terris
Keyword(s):  
Body Mass Index ◽  
Clinical Stage ◽  
Long Term Results ◽  
Apnea Hypopnea Index ◽  
Type I ◽  
Obstructive Sleep ◽  
The Mean ◽  
Anterior Palatoplasty

OBJECTIVE: Review long-term results of the modified cautery-assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea (OSA). STUDY DESIGN: Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea-hypopnea index (AHI) from 1.0 to 30.0. The mean follow-up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia. RESULTS: There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired. CONCLUSION: This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA.

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results

2005 ◽  
Vol 119 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Cem Uzun ◽  
Recep Yagiz ◽  
Abdullah Tas ◽  
Mustafa K Adali ◽  
Muhsin Koten ◽  
...  
Keyword(s):  
Middle Ear ◽  
Long Term Results ◽  
Type I ◽  
Canal Wall ◽  
Auricular Cartilage ◽  
Cortical Mastoidectomy ◽  
Thin Bridge ◽  
Stage 1

The combined Heermann and Tos (CHAT) technique is the combination of Heermann’s ’cartilage palisade tympanoplasty’ and Tos’s ’modified combined approach tympanoplasty = modified intact canal wall mastoidectomy’. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14–57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7–30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

scholarly journals Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

2020 ◽  
Vol 24 (12) ◽  
pp. 1271-1276
Author(s):  
R.-H. Chan ◽  
S.-C. Lin ◽  
P.-C. Chen ◽  
W.-T. Lin ◽  
C.-H. Wu ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Long Term Results ◽  
Endoscopic Dilation ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Aggressive Management ◽  
Anastomotic Strictures

Abstract Background Postoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon. Methods A retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005–December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed. Results There were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33–84 years). The median follow-up period was 56 months (interquartile range 22.5–99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis. Conclusions Endoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation

2012 ◽  
Vol 17 (5) ◽  
pp. 381-387 ◽  
Author(s):  
Alex Alfieri ◽  
Giampietro Pinna
Keyword(s):  
Craniocervical Junction ◽  
Long Term Results ◽  
Symptom Duration ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Duration Of Symptoms ◽  
Initial Symptoms ◽  
Csf Leakage

Object There is little information about the long-term effectiveness and complications following decompressive surgery for syringomyelia related to Chiari malformation Type I (CM-I). Methods Examining long-term clinical and radiological follow-up, the authors studied a mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration, and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated. Results The retrospective arm consisted of 41 cases treated between 1990 and 1994, and the prospective arm comprised 68 patients treated between 1994 and 2001. The mean overall age was 45.9 years, and 58.8% of the population was female. The median follow-up period was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative death or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with 3 cases (2.7%) of CSF leakage. Regression analysis showed that the best combination of clinical and radiological outcome predictors was age and duration of symptoms. Clinical follow-up confirmed surgical result stability with clinical improvement of greater than 90% of the spinal and cranial manifestations over a long-term period. Two patients had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery. Conclusions Certain clinical predictors of poor clinical and radiological prognosis were identified—namely, age at time of surgery and symptom duration. The results of the study provide additional long-term data that support the effectiveness and safety of relieving CSF block at the craniocervical junction in CM-I–related syringomyelia.

Syndactyly—A Review and Long Term Results

HAND ◽  
1977 ◽  
Vol os-9 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Peter M. Brown
Keyword(s):  
Surgical Treatment ◽  
Long Term Results ◽  
Anatomical Distribution ◽  
Long Term Follow Up ◽  
Relationship Of ◽  
The Relationship ◽  
Results Of Surgery

Syndactyly is classified and the principles of its surgical treatment discussed. The notes of eighty-five patients who had 222 webs between them were reviewed. A long term follow-up was carried out on thirty-two of these patients who had seventy-six clefts separated. The sexual and anatomical distribution of the syndactyly was investigated. The results of surgery were assessed including complications, and the relationship of complications to the type of graft used and the age at operation. It is suggested that complicated syndactyly is often separated at too early an age.

scholarly journals Takayasu’s aortoarteritis

2005 ◽  
Vol 52 (3) ◽  
pp. 95-98 ◽  
Author(s):  
Lazar Davidovic ◽  
R. Sindjelic ◽  
Z. Jovanovic ◽  
V. Bozic ◽  
D. Markovic
Keyword(s):  
Vascular Graft ◽  
Complex Disease ◽  
Far East ◽  
Proximal Part ◽  
Long Term Results ◽  
Type I ◽  
Therapeutic Approaches ◽  
Arterial Lesions

Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu?s aortoarteritis, are presented here. both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurological symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediately after the operation and during the first three postoperative months. By this reason an infection at the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu?s aortoarteritis is very uncommon in our country, as well as in other countries which don?t belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu?s aortoarteritis is a complex disease. It requires combined diagnostic and therapeutic approaches which produce satisfied long-term results.

scholarly journals The long-term results of benign bile duct strictures reconstruction

2003 ◽  
Vol 131 (1-2) ◽  
pp. 55-59
Author(s):  
Radoje Colovic ◽  
Dragoljub Bilanovic ◽  
Miodrag Jovanovic ◽  
Nikica Grubor
Keyword(s):  
Bile Duct ◽  
Long Term Results ◽  
Type I ◽  
Unsatisfactory Result ◽  
Type Iv ◽  
Intrahepatic Lithiasis ◽  
Endemic Nephropathy ◽  
Mean Time

Over 27 year period (1.01.1974-31.12.2001) a 168 patients (pts) were operated on for benign bile duct strictures of types I to IV according to Bismuth,s classification. Reconstruction of fresh lesions and lesions and strictures of sectoral or segmental ducts were not taken into account. The later are to be the subject of separate publication. There were 107(63,7%) women and 61(36,3%) men of average age of 46 years (ranging from 14 to 76 years). The average time from injury to our reconstruction was 8,2 years. In 162 pts (96,4%) an operative injury was the cause of the stricture, in 150 (89,3%) during cholecystectomy, in 8 (4,76%) during distal gastrectomy for duodenal ulcer and in 4 (2,38%) during surgery of the central hydatid cyst of the liver. In 112 (66,66%) pts 1 to 6 previous attempts of reconstructions had been performed elsewhere. According to the Bismuth,s classification there were 27 (16,07%) strictures of type I, 46 (27,38%) of type II, 66 (39,28%) of type III and 29 (17,26%) of type IV. The most frequent preoperative complications were intrahepatic lithiasis (34%), fibrosis or cirrhosis of the liver in 9,5%, liver abscesses in 6%, bilioduodenal fistula in 4,16% biliary peritonitis in 4,16% and incisional hernia in 8,9% of pts. Suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-Y jejunal limb described by Blumgart was performed in 161 (95,8%), choledochoduodenostomy in 3 (1,8%) and strictureplasty in 2 (1,2%) while in 2 pts the reconstruction was not technically possible. Three pts died during the first 6 months, 2 in whom the reconstruction was not possible and 1 with chronic endemic nephropathy. Eight of the rest 165 pts were lost from follow up being from Bosnia and Croatia due to well known war events. Six out of the 157 pts died in the mean time, 2 due to variceal bleeding (they had cirrhosis and portal hypertension at the time of reconstruction) an 4 due to unrelated causes (2 due to pancreatic carcinoma, 1 due to myocardial infarction and 1 due to stroke). Out of 151 alive fully followed pts, good result (pts symptom-free as after standard cholecystectomy) was achieved in 121 (80,13%), satisfactory (mild occasional symptoms but not cholangitis) in 27 (17,88%) and unsatisfactory result in 3 pts (2%), 2 of which were successfully reoperated (1 passed into group with good and 1 into group with satisfactory results).

Endoscopic Sphincterotomy: Long-term Results in 408 Patients with Complete Follow-up

Endoscopy ◽  
1988 ◽  
Vol 20 (01) ◽  
pp. 13-17 ◽  
Author(s):  
S. Ikeda ◽  
M. Tanaka ◽  
S. Matsumoto ◽  
H. Yoshimoto ◽  
H. Itoh
Keyword(s):  
Endoscopic Sphincterotomy ◽  
Long Term Results

722 SAFE (SUPERCHARGED CERVICAL ANASTOMOSIS FOR ESOPHAGECTOMY AND GASTRIC PULL-UP) PROCEDURE: LONG TERM RESULTS FROM 61 PATIENTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
F Takeda ◽  
R Tutihashi ◽  
R Aissar Sallum ◽  
F Busnardo ◽  
U Ribeiro ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Anastomotic Stricture ◽  
Locally Advanced ◽  
Long Term Results ◽  
Surgical Time ◽  
Cervical Anastomosis ◽  
Venous Anastomosis ◽  
Before And After

Abstract   Esophagectomy still represents a challenge surgical procedure. Anastomotic leakage is the most feared complication and is likely related to diminished anastomotic perfusion. ‘Supercharged’ microvascular anastomosis has been performed in select patients to supplement the blood supply to the graft and anastomosis, after esophagectomy. This study aimed to evaluate results after performing the supercharged cervical anastomosis for esophagectomy procedure. Methods This prospective cohort study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were selected in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas were evaluated using indocyanine and SPY before and after supercharged cervical anastomosis for esophagectomy. Post esophagectomy complications were also recorded. Results The study enrolled 61 patients, which included 47 (77.0%) men, with a mean age of 67.3 years. Median additional surgical time was 112 min (IQ 90–180), Leakage occurred in 1.6% of the patients (microanastomosis thrombosis), whereas the corresponding anastomotic stricture rates were 3.2% (mean follow-up was 25 mounths). Perfusion analyses showed a 28% improvement in the anastomotic area after venous anastomosis and a 37% improvement after arterial and venous anastomosis. Conclusion The supercharged cervical anastomosis for esophagectomy procedure may be related to low occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.

scholarly journals Endovascular treatment of abdominal aortic aneurysms in high-surgical-risk patients

2009 ◽  
Vol 8 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Célio Teixeira Mendonça ◽  
Ricardo Cesar Rocha Moreira ◽  
Cláudio Augusto de Carvalho ◽  
Bárbara D´Agnoluzzo Moreira ◽  
Janaína Weingärtner ◽  
...  
Keyword(s):  
Operative Mortality ◽  
Aortic Aneurysms ◽  
Long Term Results ◽  
Secondary Patency ◽  
Surgical Risk ◽  
Abdominal Aortic ◽  
High Surgical Risk ◽  
Risk Patients

Background: Following the publication of a prospective randomized trial (Endovascular Aneurysm Repair Trial 2 - EVAR2) that questioned the benefits of endovascular repair of abdominal aortic aneurysms (AAA) in high-surgical-risk patients, we decided to analyze our initial and long-term results with endovascular AAA repair in this patient population. Objective: To evaluate the operative mortality, long-term survival, frequency of secondary operations, outcome of the aneurysm sac, primary and secondary patency rates, and rupture rate after aortic stent-graft placement in high-surgical-risk patients. Methods: From April 2002 to February 2008, 40 high-surgical and anesthetic risk patients with an AAA managed by a bifurcated aortic endograft were entered in a prospective registry. Data concerning diagnosis, operative risk, treatment and follow-up were analyzed in all patients Results: Twenty-four Excluder® and 16 Zenith® stent-grafts were successfully implanted. Thirty patients (75%) were classed ASA III and 10 (25%) were ASA IV. Mean aneurysm diameter was 64 mm. Operative mortality was 2.5%. Two patients required reintervention during the mean follow-up of 28.5 months. Survival rate at 3 years was 95%. There were four endoleaks, one case of endotension, and one endograft limb occlusion. Primary and secondary patency rates at 3 years were 97.5 and 100%, respectively. There were no ruptures. Conclusions: Initial and long-term results with endovascular treatment of AAA in high-surgical-risk patients were satisfactory, and appear to justify such approach for this patient population.

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